Diagnosing Peripheral Neuropathy in South East Asia: A Focus on Diabetic Neuropathy.

Burning and stabbing pain in the feet and lower limbs can have a significant impact on the activities of daily living including walking, climbing stairs and sleeping. Peripheral neuropathy (PN) in particular is often misdiagnosed or underdiagnosed due to a lack of awareness amongst both patients and physicians. Furthermore, crude screening tools such as the 10g monofilament only detect advanced neuropathy and a normal test will lead to false reassurance of those with small fiber mediated painful neuropathy. The underestimation of PN is highly prevalent in the South East Asia (SEA) region due to a lack of consensus guidance on routine screening and diagnostic pathways. Although neuropathy due to diabetes is the most common cause in the region, other causes due to infections (human immunodeficiency virus, hepatitis B or C virus), chronic inflammatory demyelinating polyneuropathy, drug induced neuropathy (cancer chemotherapy, antiretrovirals and anti-tuberculous drugs) and deficiencies in vitamins (B1, B6, B12, D) should be actively excluded.